Brachytherapy最新文献

{"title":"Randomized trial comparing hypnosis versus standard management on patient anxiety and pain during pelvic brachytherapy applicator removal","authors":"Lydie Lemoine ,&nbsp;Virginie Adam ,&nbsp;Julia Salleron ,&nbsp;Christelle Cuisinier ,&nbsp;July Perrin ,&nbsp;Claire Charra Brunaud ,&nbsp;Py Jean-François ,&nbsp;Marie Bruand ,&nbsp;Didier Peiffert ,&nbsp;Rémi Etienne ,&nbsp;Cécile Huin Schohn ,&nbsp;Sophie Renard","doi":"10.1016/j.brachy.2025.07.010","DOIUrl":"10.1016/j.brachy.2025.07.010","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Removal of brachytherapy applicator is routinely performed under premedication including Kalinox® gas inhalation without general anesthesia. The applicator removal is nevertheless associated with discomfort, anxiety or pain. We assessed the adjunction of formal hypnosis during this procedure.</div></div><div><h3>METHODS AND MATERIALS</h3><div>This prospective, randomized, single-center study focused on adult patients undergoing pelvic brachytherapy applicator removal. Patients were randomly assigned to (1:1): standard management including Kalinox® (control group) vs. standard management including Kalinox® accompanied by formal hypnosis (hypnosis group). The primary endpoint was anxiety using the State-Trait Anxiety Inventory (STAI) Y-A form (state anxiety). A secondary endpoint was pain after applicator removal (numerical scale).</div></div><div><h3>RESULTS</h3><div>A total of 68 patients (mean age, 51.9 years) were included (cervical cancer, 86.6%). Before applicator removal, mean (SD) STAI Y-A anxiety score was 45.9 (5.6) in the control group vs. 47.5 (5.9) in the hypnosis group. After applicator removal, the scores were 48.1 (4.3) versus 47.7 (4.2), respectively (<em>p</em> = 0.76). Pain score was not significantly different after applicator removal (<em>p</em> = 0.055) in the hypnosis group compared to the control group: 1.29 (1.72) versus 0.71 (1.51), respectively. There were no significant differences between the 2 groups concerning caregiver satisfaction with patient management (<em>p</em> = 0.27), ease of realization (<em>p</em> = 0.17) and caregiver comfort (<em>p</em> = 0.42).</div></div><div><h3>CONCLUSION</h3><div>This study failed to demonstrate a substantial benefit of formal hypnosis on anxiety in patients undergoing pelvic brachytherapy applicator removal. But this study suggests that the use of hypnotic communication techniques enables a positive attitude to patient care, thus reinforcing the patient-caregiver relationship.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 854-862"},"PeriodicalIF":1.8,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosimetric characterization and experimental validation for a low-kV FPXS electronic brachytherapy system","authors":"Mengke Qi ,&nbsp;Sifu Luo ,&nbsp;Jing Kang ,&nbsp;Song Kang ,&nbsp;Xingyu Lu ,&nbsp;Ting He ,&nbsp;Liang Cui ,&nbsp;Jun Chen ,&nbsp;Linghong Zhou ,&nbsp;Yuan Xu","doi":"10.1016/j.brachy.2025.07.008","DOIUrl":"10.1016/j.brachy.2025.07.008","url":null,"abstract":"<div><h3>PURPOSE</h3><div>This study aims to evaluate the feasibility of using flat-panel X-ray source (FPXS) for brachytherapy through preclinical animal irradiation experiments.</div></div><div><h3>MATERIAL AND METHODS</h3><div>A low-kV FPXS electronic brachytherapy (EB) system was constructed for dosimetry measurements and experimental validation. The surface and depth dose characteristics of FPXS were measured employing a 34013 chamber. An FPXS-based EB workflow was established, enabling the calculation of required exposure times for FPXS at a given prescription dose. The accuracy of the delivered dose and the therapeutic efficacy of FPXS irradiation were validated through brachytherapy experiments conducted on murine models with breast cancer.</div></div><div><h3>RESULTS</h3><div>The FPXS operates with a maximum voltage of up to 50 kV and a maximum surface dose rate exceeding 2.30 Gy/min. The surface dose rate and current demonstrate an exponential increase with voltage, and the dose rate exhibits a linear correlation with the current. The calculated cumulative dose delivered to mice in the experimental group was slightly higher than the average in-field dose measured by film (21.88±0.61 Gy vs. 20.83 ± 1.03 Gy). Following FPXS irradiation, the increase in tumor volume of mice in the experimental group was markedly less pronounced than that observed in the control group, and the survival rate of mice in the experimental group over time was significantly higher than that of the control group (66.67% vs 12.50%).</div></div><div><h3>CONCLUSION</h3><div>The intensity of FPXS is comparable to current EB systems, and its surface dose rate is adequate for therapeutic applications. Animal irradiation experiments confirm the accuracy of FPXS-delivered doses and demonstrate its efficacy in tumor irradiation.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 900-910"},"PeriodicalIF":1.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative low-dose rate brachytherapy as an adjunct to surgery for marginally resectable rectal and recurrent anorectal carcinomas","authors":"Mustafa M. Al Balushi ,&nbsp;Teresia M. Perkins ,&nbsp;Kee-Young Shin ,&nbsp;Ivan M. Buzurovic ,&nbsp;Simon G. Talbot ,&nbsp;Joel E. Goldberg ,&nbsp;Desmond A. O’Farrell ,&nbsp;Martin T. King ,&nbsp;Harvey J. Mamon ,&nbsp;Philip M. Devlin","doi":"10.1016/j.brachy.2025.07.009","DOIUrl":"10.1016/j.brachy.2025.07.009","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Locally recurrent and marginally resectable rectal and anorectal carcinomas present significant therapeutic challenges due to high recurrence rates and limited treatment options. Intraoperative low-dose rate brachytherapy (LDRBT) has emerged as a potential adjunct to improve local control in these cases. This study aims to evaluate the clinical outcomes associated with intraoperative LDRBT for these difficult cases.</div></div><div><h3>METHODS</h3><div>This was a retrospective study that was approved by the institutional review board. Patients who had undergone intraoperative pelvic LDRBT for locally recurrent and marginally resectable rectal and anorectal carcinomas between February 2004 and April 2022 were included. Morbidity and survival were assessed using toxicity CTCAE V5.0 and Kaplan-Meyer curves, respectively.</div></div><div><h3>RESULTS</h3><div>29 patients were found to have been treated with surgical resection and intraoperative pelvic seed brachytherapy with either I-125 or Cs-131. The 1-year and 2-year overall survival rates were 88.7% (95% CI, 69.0–96.2) and 70.6% (95% CI, 47.7–84.9), respectively. Furthermore, the 1-year and 2-year local progression free survival rates were 55.4% (95% CI, 34.9–71.8) and 41.7% (95% CI, 22.3–60.1), respectively. Median number of months for local progression free survival was 15.6% (95% CI, 7.4–34.4). The most common toxicity was Grade 1–2 neuralgia in 41.4% of patients, with no Grade 4 or higher observed.</div></div><div><h3>CONCLUSION</h3><div>Our results suggest that intraoperative LDRBT may play a broader role in managing these challenging conditions. Morbidity was moderate and primarily dependent on disease progression. Survival and progression rates were consistent with published reports, highlighting the therapeutic potential of this treatment approach.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 931-939"},"PeriodicalIF":1.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of variability in applicator position and organs at risk dose in fractionated intracavitary brachytherapy for cervical cancer","authors":"Francis Kazoba ,&nbsp;Elingarami Sauli ,&nbsp;Elias Nyanza ,&nbsp;Aloyce I. Amasi","doi":"10.1016/j.brachy.2025.07.012","DOIUrl":"10.1016/j.brachy.2025.07.012","url":null,"abstract":"<div><h3>Background</h3><div>Cervical cancer remains a major cause of mortality in low- and middle-income countries (LMICs). Intracavitary brachytherapy (ICBT) is critical for curative radiotherapy; however, inter-fractional variability in applicator positioning may compromise treatment reproducibility and organ-at-risk (OAR) sparing.</div></div><div><h3>Objective</h3><div>This study assessed inter-fractional applicator positional stability and its dosimetric impact on OARs during fractionated ICBT for cervical cancer.</div></div><div><h3>Materials and methods</h3><div>A prospective analysis of 60 treatment plans from 20 patients receiving three ICBT fractions was conducted. Applicator shifts along the X, Y, and Z axes and corresponding bladder and rectal doses were evaluated. Descriptive statistics and repeated measures ANOVA determined positional reproducibility and dose variability, while correlation analysis examined associations between applicator displacement and OAR dose changes.</div></div><div><h3>Results</h3><div>Applicator positioning was reproducible across fractions, with no significant differences in any axis <em>p</em> &gt; 0.05). Bladder dose, however, demonstrated significant variation (<em>p</em> = 0.027), progressively increasing across fractions. Moderate correlations (<em>r</em> ≈ 0.39) were observed between bladder dose escalation and applicator shifts along the X and Y axes, especially in the Y-axis. Rectal dose remained stable (<em>p</em> = 0.776).</div></div><div><h3>Conclusion</h3><div>Although applicator positioning was geometrically stable, significant bladder dose variability occurred. Adaptive replanning and real-time imaging are recommended to optimize treatment precision in fractionated ICBT.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 872-882"},"PeriodicalIF":1.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A machine learning-based decision support tool for standardizing intracavitary versus interstitial brachytherapy technique selection in high-dose-rate cervical cancer","authors":"Tomohiro Kajikawa ,&nbsp;Koji Masui ,&nbsp;Koji Sakai ,&nbsp;Tadashi Takenaka ,&nbsp;Gen Suzuki ,&nbsp;Yuki Yoshino ,&nbsp;Hikaru Nemoto ,&nbsp;Hideya Yamazaki ,&nbsp;Kei Yamada","doi":"10.1016/j.brachy.2025.07.011","DOIUrl":"10.1016/j.brachy.2025.07.011","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To develop and evaluate a machine-learning (ML) decision-support tool that standardizes selection of intracavitary brachytherapy (ICBT) versus hybrid intracavitary/interstitial brachytherapy (IC/ISBT) in high-dose-rate (HDR) cervical cancer.</div></div><div><h3>METHODS AND MATERIALS</h3><div>We retrospectively analyzed 159 HDR brachytherapy plans from 50 consecutive patients treated between April 2022 and June 2024. Brachytherapy techniques (ICBT or IC/ISBT) were determined by an experienced radiation oncologist using CT/MRI-based 3-D image-guided brachytherapy. For each plan, 144 shape- and distance-based geometric features describing the high-risk clinical target volume (HR-CTV), bladder, rectum, and applicator were extracted. Nested five-fold cross-validation combined minimum-redundancy–maximum-relevance feature selection with five classifiers (k-nearest neighbors, logistic regression, naïve Bayes, random forest, support-vector classifier) and two voting ensembles (hard and soft voting). Model performance was benchmarked against single-factor rules (HR-CTV &gt; 30 cm³; maximum lateral HR-CTV–tandem distance &gt; 25 mm).</div></div><div><h3>RESULTS</h3><div>Logistic regression achieved the highest test accuracy 0.849 ± 0.023 and a mean area-under-the-curve (AUC) 0.903 ± 0.033, outperforming the volume rule and matching the distance rule’s AUC 0.907 ± 0.057 while providing greater accuracy 0.805 ± 0.114. These differences were not statistically significant. Feature-importance analysis showed that the maximum HR-CTV–tandem lateral distance and the bladder’s minimal short-axis length consistently dominated model decisions.​<!--> </div></div><div><h3>CONCLUSIONS</h3><div>A compact ML tool using two readily measurable geometric features can reliably assist clinicians in choosing between ICBT and IC/ISBT, thereby reducing inter-physician variability and promoting standardized HDR cervical brachytherapy technique selection.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 863-871"},"PeriodicalIF":1.8,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A biologically effective dose–based framework for integrating LDR brachytherapy and EBRT in glioblastoma treatment","authors":"Adam C. Turner ,&nbsp;Elliot M. Abbott ,&nbsp;Michael A. Garcia ,&nbsp;Sita Patel ,&nbsp;Kimberly M. Johnson ,&nbsp;David G. Brachman","doi":"10.1016/j.brachy.2025.07.003","DOIUrl":"10.1016/j.brachy.2025.07.003","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Radiation therapy is a core component of the standard of care (SOC) for glioblastoma (GBM), yet outcomes remain poor. Rapid early progression (REP) between maximal safe resection and start of external beam radiation therapy (EBRT) is associated with reduced survival. The GESTALT trial (NCT05342883) investigates whether initiating low-dose-rate brachytherapy (LDRBT) at time of resection can mitigate rates of REP prior to EBRT. This work presents a framework for integrating LDRBT and EBRT to deliver a composite biologically effective dose (BED) distribution comparable to SOC and demonstrates its feasibility for clinical use.</div></div><div><h3>METHODS</h3><div>A voxel-level optimization framework was developed to account for LDRBT BED when planning EBRT. The method was applied to generate EBRT plans for 34 GESTALT trial patients following resection and intraoperative implantation of GammaTile® cesium-131 LDRBT devices. Plan quality metrics and doses to organs at risk (OAR) were compared to trial requirements to demonstrate feasibility and safety.</div></div><div><h3>RESULTS</h3><div>Mean composite target dose coverage was statistically equivalent to prescribed doses while achieving similar dose conformity as SOC EBRT delivered using modern techniques. Composite dose constraints for OARs were met in most cases, with constraint violations observed in fewer than 10% of patients for any individual structure.</div></div><div><h3>CONCLUSION</h3><div>These findings demonstrate the feasibility of a novel approach to account for LDRBT when optimizing EBRT to deliver a desired composite BED. These results support earlier initiation of radiation with LDRBT for GBM and establish a basis for forthcoming analyses of clinical outcomes and model performance in the GESTALT trial.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 949-960"},"PeriodicalIF":1.8,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iterative intraoperative 3T MRI (iMRI)-guided brachytherapy: A prospective study on enhancing implantation precision and dosimetric gains in advanced gynecologic cancers","authors":"Shrikiriti S. Rajan ,&nbsp;Matthew S. Ning ,&nbsp;Megan Jacobson ,&nbsp;Samantha J. Simiele ,&nbsp;Teresa Bruno ,&nbsp;Ramez Kouzy ,&nbsp;Kyoko Yoshida-Court ,&nbsp;Tatiana Cisneros-Napravnik ,&nbsp;Henry Yu ,&nbsp;Jason Stafford ,&nbsp;Yusung Kim ,&nbsp;Geena Mathew ,&nbsp;Rauda Alicia Cordova ,&nbsp;Maliah Domingo ,&nbsp;Anuja Jhingran ,&nbsp;Lilie L. Lin ,&nbsp;Melissa Joyner ,&nbsp;Travis T. Sims ,&nbsp;Lauren Colbert ,&nbsp;Aradhana M. Venkatesan ,&nbsp;Ann Klopp","doi":"10.1016/j.brachy.2025.06.010","DOIUrl":"10.1016/j.brachy.2025.06.010","url":null,"abstract":"<div><h3>Purpose</h3><div>To report on primary outcomes and dosimetric results of a prospective clinical trial and protocol for use of iterative intraoperative magnetic resonance imaging (iMRI) in gynecologic brachytherapy.</div></div><div><h3>Methods</h3><div>Patients with locally advanced cervical or vaginal cancer (FIGO stages IB2 – IVA, and stage II-IVA, respectively) undergoing pulsed dose rate (PDR) brachytherapy were enrolled in a prospective clinical trial (NCT03634267) using iterative 3T iMRI during brachytherapy implant placement. Applicator and optional interstitial needles were placed under iMRI guidance in a 3T clinical MRI scanner. Imaging, dosimetry and clinical outcomes (local control (LC), recurrence-free survival (RFS), overall survival (OS)), and acute and long-term toxicity were evaluated prospectively and confirmed by chart review. To explore dosimetric gains, an EQD2 estimate comparing iMRI-guidance versus standard of care guidance, as well as a 3-patient analysis of dose changes with iMRI-guided optimization was included.</div></div><div><h3>Results</h3><div>Fourteen patients underwent iMRI-guided brachytherapy. Seventy percent (70%) of patients presented with FIGO stage III disease or higher. Median follow-up was 44 months. . Patients had 2-year median LC, RFS, and OS rates of 83.3%, 76%, and 84.6%, respectively. Acute toxicities were minimal with one (1) case of grade 3 nausea. No grade 3 or higher long-term toxicities were observed. Median operating room (OR) time was 283 minutes (range 174-380 mins). On exploratory analysis, implant placement performed with iMRI guidance demonstrated higher HR-CTV D90 doses (mean difference of +784.7 cGy, <em>p</em> = NS) were achieved compared to US and CT guided implantation in the same patients.</div></div><div><h3>Discussion</h3><div>iMRI-guidance for gynecologic brachytherapy is safe, associated with minimal high-grade toxicity and excellent clinical outcomes. Future studies to optimize resource use, image acquisition efficiency, and identifying predictive imaging features are warranted.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 844-853"},"PeriodicalIF":1.8,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144860000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accessory secondary plaque in brachytherapy for uveal melanoma","authors":"Weilin Song ,&nbsp;Adrian Au ,&nbsp;Angela Oh ,&nbsp;Alan W. Kong ,&nbsp;James Lamb ,&nbsp;Tara A. McCannel","doi":"10.1016/j.brachy.2025.05.003","DOIUrl":"10.1016/j.brachy.2025.05.003","url":null,"abstract":"<div><h3>PURPOSE</h3><div>We describe the technique, indications and outcomes of an accessory secondary brachytherapy plaque for the treatment of uveal melanoma to provide supplemental tumor coverage for the primary brachytherapy plaque.</div></div><div><h3>METHODS</h3><div>Retrospective case series was performed to identify brachytherapy plaque cases for the treatment of primary uveal melanoma where an accessory secondary plaque was created to improve treatment coverage of the uveal melanoma, and positioned at the time of removal of the primary brachytherapy plaque. Baseline tumor, patient characteristics, and clinical outcomes including tumor control, visual acuity, treatment complications, metastases and death treatment were obtained.</div></div><div><h3>RESULTS</h3><div>Of 1,144 uveal melanomas treated with brachytherapy over a 19-year period, eight (0.7%) cases were identified where an accessory secondary brachytherapy plaque was used. Six (75%) patients had uveal melanoma involving the ciliary body. After a mean follow up period of 31.5 ± 5.65 (SE) months, seven (87.5%) patients maintained tumor control and the mean visual acuity was logMAR 0.84 ± 0.57 (Snellen equivalent 20/138). Two (25%) patients developed metastasis, and one (12.5%) patient died of metastatic disease.</div></div><div><h3>CONCLUSION</h3><div>An accessory brachytherapy plaque is a practical solution to manage unexpected deficiencies in plaque coverage of the primary melanoma which avoids treatment delay and minimizes time for potential tumor growth. It may also avoid suboptimal adjunctive treatment options, such as transpupillary thermotherapy, and eliminates radioactive source loss if an entirely new brachytherapy plaque was created. A well-matched accessory secondary plaque may also better conform to the target than a generic plaque with a larger diameter.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 5","pages":"Pages 807-813"},"PeriodicalIF":1.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gel spacer-assisted salvage brachytherapy for pelvic recurrence after definitive chemoradiotherapy in cervical cancer: A single-institution retrospective study","authors":"Kae Okuma ,&nbsp;Naoya Murakami ,&nbsp;Koji Inaba ,&nbsp;Tairo Kashihara ,&nbsp;Akane Yoshiba ,&nbsp;Ayaka Nagao ,&nbsp;Kana Takahashi ,&nbsp;Madoka Sakuramachi ,&nbsp;Hiroshi Igaki","doi":"10.1016/j.brachy.2025.07.002","DOIUrl":"10.1016/j.brachy.2025.07.002","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To evaluate the safety and efficacy of gel spacer-assisted high-dose-rate (HDR) salvage brachytherapy for pelvic recurrence after definitive chemoradiotherapy (CRT) for cervical cancer.</div></div><div><h3>METHODS AND MATERIALS</h3><div>We retrospectively analyzed 15 consecutive patients who underwent salvage HDR interstitial brachytherapy for pelvic recurrence following definitive CRT for cervical cancer between 2016 and 2024. Gel spacers were injected between the recurrent tumors and adjacent organs at risk (OARs), mainly the rectum and bladder, under transrectal ultrasound guidance at each brachytherapy session. The spacer’s effectiveness was evaluated by comparing the hypothetical dose delivered to the gel spacer volume (assuming no spacer was used) with the actual dose to the OARs.</div></div><div><h3>RESULTS</h3><div>The median biological equivalent dose in 2-Gy fractions (EQD2, α/β = 10) delivered during reirradiation was 64.0 Gy (range: 44.5–72.0 Gy). After a median follow-up of 22 months (range: 0–93 months), the complete response rate was 66.7% (10/15). Gel spacer injection significantly reduced the rectal D2cc by a median of 29% (interquartile range [IQR]: 14%–55%) and the bladder D2cc by 16% (IQR: 10%–34%) compared with the hypothetical dose estimates assuming no spacer use (Wilcoxon signed-rank test, <em>p</em> &lt; 0.001). Grade ≥3 late toxicities occurred in only one patient (10.0%) among complete responders, and no spacer-related adverse events were observed.</div></div><div><h3>CONCLUSIONS</h3><div>Gel spacer-assisted salvage brachytherapy significantly reduced radiation exposure to critical OARs, particularly the rectum, while achieving effective tumor control in patients with pelvic recurrence of cervical cancer after definitive CRT. These promising results support this approach as a feasible and safe strategy, warranting further validation in larger prospective studies.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 5","pages":"Pages 684-693"},"PeriodicalIF":1.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-operative process efficiency for in-room MRI-guided combined intracavitary/interstitial brachytherapy for cervical cancer","authors":"Kitty Chan ,&nbsp;Heather Ballantyne ,&nbsp;Zhihui Amy Liu ,&nbsp;Michael Milosevic ,&nbsp;Jennifer Croke ,&nbsp;Anthony Fyles ,&nbsp;Jelena Lukovic ,&nbsp;Alexandra Rink ,&nbsp;Akbar Beiki-Ardakani ,&nbsp;Jette Borg ,&nbsp;Monica Serban ,&nbsp;Robert A. Weersink ,&nbsp;Jessica L. Conway ,&nbsp;Sarah Rauth ,&nbsp;Julia Skliarenko ,&nbsp;Jason Xie ,&nbsp;Anna Simeonov ,&nbsp;Kathy Han","doi":"10.1016/j.brachy.2025.07.001","DOIUrl":"10.1016/j.brachy.2025.07.001","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Magnetic resonance image-guided brachytherapy (MRgBT) is the gold-standard treatment for cervical cancer. This study examined workflow times in an integrated MRgBT suite and conventional operating room (OR), and factors contributing to intraoperative efficiency.</div></div><div><h3>METHODS AND MATERIALS</h3><div>Consecutive patients with FIGO stage IB-IVA cervical cancer who underwent MRgBT procedures between 2019-2022 were retrospectively reviewed. Workflow times were collected: applicator insertion, MR-imaging, contouring, treatment planning, treatment execution and total procedure time. Procedure durations between applicators and over time were compared.</div></div><div><h3>RESULTS</h3><div>The 161 patients included in this study underwent 267 procedures in the MRgBT suite, and 56 procedures in the OR using ovoid and tandem applicator (O&amp;T, 46%), ring and tandem (R&amp;T, 28%), or Syed-Neblett template (Template, 27%). The median duration (minutes) of each step was: general anesthesia induction (<span><span>18</span></span>), applicator insertion (31), MR-imaging (28), parallel contouring (48) and applicator/needle registration &amp; treatment plan optimization (83), and treatment execution (19). Total procedure time was much longer in the OR (488 minutes) than MRgBT suite (205 minutes). Template cases were significantly longer in insertion, MR-imaging, contouring, planning and total procedure time (by 52 minutes) compared with those using the R&amp;T/O&amp;T applicators (p&lt;0.001). Total procedure time for Template cases reduced by 10 minutes/year since 2019 (p&lt;0.001). Regardless of applicator type, total procedure time for subsequent insertions was 21 minutes less than the first (p&lt;0.001).</div></div><div><h3>CONCLUSIONS</h3><div>MRgBT procedure time was longer for Syed-Neblett template cases, but shorter in subsequent insertions. The overall procedure time was much shorter in the integrated MRgBT suite than conventional OR.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 5","pages":"Pages 729-737"},"PeriodicalIF":1.8,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}